I accept your challenge, Mr Williams, and will run a series of real stories, anonymized of course, which will illustrate the real, undeniable, human tragedies which are the result of the crisis in access to health insurance and health care.

I will start with a recent case, because it was memorable and so aptly illustrates Mr Williams' utter disconnect from the reality of America's "Greatest Health Care in the World" [tm].

Mr Jones was an African-American in his mid-fifties. He worked as a framer, was married, and had three children in their early teens. African-Americans are statistically more likely to be without health insurance, and he was indeed uninsured. He made too much as a framer to qualify for Medicaid, and his employers did not offer insurance. In our state, individual policies are very expensive; almost prohibitively so, and Mr Jones had a history of high blood pressure, which would probably have drastically increased the cost or excluded him altogether. I do not know whether he "chose" to go without insurance or whether he tried and failed to obtain it, but it doesn't really matter. He had tried to be seen at the local charity clinic for blood pressure medications, but had given up because the clinic was overbooked and he could never get an appointment that didn't conflict with his work schedule.

I never found out what sort of person he was -- whether he was a pleasant, good hard-working family man, or whether he was a grumpy old cuss, whether he tried to take care of himself or whether he ignored his health and smoked and drank and ate fatty foods. I do know that his family thought the world of him and he was apparently dedicated to them, and that he collapsed in front of them on a Saturday morning.

When he was brought to me his blood pressure was 240/125, and he was deeply comatose. The paramedics had put in a breathing tube and he was not responding even to painful stimuli. I gave him medicine to bring down his blood pressure and obtained a CT scan of his brain. It looked something like this:This is not his scan -- I didn't happen to save the image, but it's pretty close. There is a large amount of blood in the brain tissue and the ventricles. This is typical of a hemorrhage caused by longstanding high blood pressure which weakens the arteries in the brain until one of them bursts.

I admitted him to the ICU under the care of a neurosurgeon, but there was really nothing anyone could do, and he died the next morning.

In one respect, the estimable Mr Williams is right -- this patient didn't die in the street. He died in the hospital. Maybe he would have died anyway, even had he been on medication. Maybe he had self-destructive tendencies and habits which contributed to his demise. We'll never know. But he had access to the health care system only for the last sixteen hours of his life. Had he been under the care of a doctor and prescribed even very inexpensive medicines, he might well be alive today.

Scalpel, perhaps you didn't look that carefully, but on the site you link to, there is this notice front and center:"Health Care Provided To the Uninsured at Risk.

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed regulation that will dramatically reduce Medicaid funding to the Harris County Hospital District — threatening access to care and needed services for low-income residents of Harris County. The proposed cuts specifically target the hospital district, which serves as the primary safety net for the community’s uninsured population."

The point is that none of the local private docs will see an uninsured patient at all (or, to be fair, the local privates have a certain number of slots available for the uninsured, all of which are full). And the "charity clinic" is overwhelmed. And he had a mortgage, so he didn't want to incur bills he couldn't pay.

So the great irony is that very inexpensive meds could indeed have treated him, but the avenues of access to care were closed or severely obstructed.

And he had a mortgage, so he didn't want to incur bills he couldn't pay.

Sounds like another case of simple prioritizing to me. He had a job, and money, but if he preferred to spend the cash on a mortgage, piano lessons, or gin it was his choice. To say his demise was the direct result of his lack of insurance is a stretch.

Yeah, that frivolous twit prioritized food and housing before insurance -- silly bastard deserved what he got. I bet he even had a car, too! Clearly it was his own choice, then. Thanks for clearing that up for me.

[/sarcasm]

The working poor generally are living hand-to-mouth. It's not easy to find an extra $11,000 in the budget for insurance when your gross take-home is ReplyDelete

In our county, someone at that income level would pay $5 for a clinic visit, $5 for each prescription, and $25 for an ER visit. No insurance needed.

Yeah, thay have to wait longer to be seen. But nobody said life was perfect, and no matter how much your heart bleeds for the underpriviliged, you can't be everyone's nanny. At some point personal responsibility has to come into play.

here's what the republicans on this thread and in society are afraid to say, so i'll say it for them.

poor people have done nothing to deserve proper healthcare treatment. at least they don't deserve treatment that in any way resembles what i receive or what anybody who makes a decent living gets. why should my hard work subsidize someone who probably sucked in school and didn't think about their future when they should have been, and now is a drain on society? you messed up, you made the wrong choices... so now, when you're sick and can't care for yourself and need a caring hand... don't come crying and bitching to me. you lose. you're a loser.

i don't care if you had a terrible childhood, i don't care if you have a chronic illness or injury, i don't care if you have a mental illness, i don't care if you struggle with addiction... or anything else that would prevent you from working and making enough money to provide all of life's amenities... you LOSE.

Does anyone question whether this man would have been more likely to get a check up if he had insurance? If you're talking about how society works, surely you have to talk about forces that push in one direction or another. On the one hand there is the cost of insuring the other fifth of our population that is uninsured, and on the other is the cost of having citizens suffer and die from treatable illnesses.

To say, "He didn't need insurance," or that it is a "case of simple prioritizing," is shocking. If your political views drive you do analyze this problem in this way, you need to do some deep questioning. What kind of person have you let yourself become? Is this the kind of person you want to be?

Seriously, read the Dhamapada, the sermon on the mount, JFK's inaugural address--something. There is sickness other than physical sickness.

Shadow - many of us appreciate your looking at this side of this extremely "hot" issue.

I won't go into details, anyone who "knows" me knows already, but my husband will soon be uninsured.

We do not qualify for assistance with his medications because of our HUGE combined income. We attempted to purchase private insurance and they REFUSED - several companies not just one or two.

So, do we buy these medications, or do we pay to keep a roof over our heads? They come to about $1300 a month. Does not include doctor visits or lab tests or anything other than prescription medications.

We live very simply - not beyond our means at all. Drive two old, paid for cars, and have a simple small house with a payment that is no more than the average rent in our county.

The uninsured aspect is not his fault -nor can his illness' be chalked up to having "brought it all on himself" - nor am I sure it would matter if he had.

He worked his way through college from 18 until he was 23 or so while paying off his mom's home because his dad died young. Worked all his life and did everything right by the book (according to the commentors here)but still wound up in this predicament.

Some folks have no compassion - no empathy - and for whatever reason are just plain bitter. Whether it be because they have never had to struggle with adversity, or just simply because they have a 'big head' and think it could never happen to them, there is no reasoning with folk like that.

And in case anyone wonders - I am about as non-liberal as they come down here in my little southern world. I'm not even sure I am proud to say I have been a republican most of my life, because it seems to me now, that the very party I have supported is the very one willing to let us fall between those cracks some of you refuse to admit exist.

What is so hard to understand? Look at the website I linked in the first comment. Plug in your financial data.

A family of 4 earning 36,000 a year pays $5 for office visit and $5 per prescription. No insurance required. Some people earning less than that pay nothing. I have done more for people in need than the whiny commenters here ever will, so how dare anyone accuse me (even indirectly) of not having compassion or empathy.

Healthcare can be provided to the lower-income population on the state and local level. We don't need more national healthcare bureaucracy.

I admitted a 50 year old man last week who had better insurance than I do. He'd had multiple ER visits over the last few years for various issues, and his blood pressure was always in the 180/100 range. It was always noted on the triage note that he had been "out of his meds" or "not taking meds" for two months, and he was always prescribed BP meds and encouraged to follow up.

When he came to see me, his BP was 260/130, but he was without any evidence of injury. I admitted him for BP control, just as I would have done had he not had insurance, and I warned him to start taking his condition more seriously.

Just a lurker....son was in auto accident recently -- lucky: broken nose & 2 lost teeth. Air lifted to Phila. when local hospital was 5 mi. away. 3 days (2 nites) total of over $130,OOO. Tests, tests, tests....get the legal system off the hospital and doctors' backs! Let them use their common sense! Luckily, he works for school district---insurance paid all but $8,000.

Many of the problems that the uninsured and underinsured face are the difficulty of gaining access to care. EMTALA has made it much easier to go to an emergency room than it is for most of the un/underinsured to enroll in public insurance programs or go to a PCP. Until some of the disincentives (bureaucratic for the patients, financial for the doctors) are addressed, cases like these will persist.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

All Content is Copyright of the author, and reproduction is prohibited without permission.